MEDICARE: MR. SCOTT HURLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	6594229-4202	UT

General Provider Information

NPI Number	:	1164627345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT HURLEY

Provider Business Mailing Address
First Line	:	191 RAINBOW DR # 9197
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77399-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E 5350 S
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-479-7543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. SCOTT HURLEY ” Practice Location

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